{"ops":[{"insert":"A 22-year-old woman is referred for further evaluation of a fractured left femur, sustained after she slipped and fell on a flat floor yesterday. X-rays showed a transverse subtrochanteric fracture, with markedly dense cortical boundaries and a reduced intramedullary diameter.\n\nHer medical and surgical histories are unremarkable, and she is not on any medications. Her mother experienced a foot fracture and a Colles fracture at the ages of 32 and 55 years respectively. These were treated individually, without further evaluation.\n\nShe is a student at the local community college, has never smoked, and only drinks socially.\n\nA complete blood count is significant for a Hb of 10.5 g\/dL (normal: 12-18), with normal MCV, MCH and MCHC values. Peripheral smears confirm normochromic normocytic anemia. A reticulocyte count is 0.5% (normal: 0.5-1.5).\n\nHer ESR, CRP, and renal and liver profiles (including serum alkaline phosphatase levels) are all within normal parameters.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-S-086_en.png"}},{"insert":"\n"}]}
2
Investigate
Serum TSH and PTH
{"ops":[{"insert":"Serum thyroid stimulating hormone (TSH) and parathyroid hormone (PTH) levels are within normal parameters.\n"}]}
Skeletal survey
{"ops":[{"insert":"Skull: thickening of the inner and outer cortical tables, with increased radiodensity at the skull base.\n \nSpine: increased radiodensity of all vertebrae, with sclerotic bands over the endplates (i.e. \u0022sandwiched vertebrae\u0022 appearance).\n \nPelvis: expanding osteosclerosis of the pelvic bones, with a \u0022bone within a bone\u0022 appearance.\n"}]}
